Lichen sclerosus

International Journal of STD & AIDS 2005; 16: 465–474

Lichen sclerosus

P D Yesudian MRCP MD 1, H Sugunendran MD DipGUM 2, C M Bates MRCP MRCGP 2 and C O’Mahony MD FRCP 3

1 Department of Dermatology, Countess of Chester Hospital, Liverpool Road,Chester CH2 1UL; 2 Department of Genitourinary Medicine, Royal Liverpool University Hospital; 3 Department of Sexual Health, Countess of Chester Hospital, Chester, UK

Summary: Lichen sclerosus (LS) is a chronic inflammatory disorder of the skin and mucosa, presenting to genitourinary physicians and dermatologists. It affects both sexes and all age groups. Although the exact aetiology is uncertain, genetic predisposition, infections and autoimmune factors have been implicated in its pathogenesis. Symptoms include pruritis and soreness, but asymptomatic presentations are not uncommon. The classical clinical picture is of atrophic white plaques in the anogenital region. Histopathology is specific with basal cell degeneration, upper dermal oedema, homogenization of collagen and a chronic inflammatory infiltrate. Short courses of potent topical corticosteroids form the mainstay of treatment. The condition tends to be remitting and relapsing, with spontaneous regressions reported in a few. In men, the term balanitis xerotica obliterans is sometimes used to describe late and severe LS of the penis. Scarring and progression to squamous cell carcinomas can occur in chronic LS, resulting in significant morbidity. A multidisciplinary approach to care and the need for longterm monitoring cannot be overemphasized.

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Early Lichen Sclerosus will become late Lichen Sclerosus – ‘Young woman with slight itching not relieved by clotrimazole. Constantly being diagnosed as ‘thrush’. Download the Powerpoint or PDF version to read.